Adverse childhood experiences, or ACEs, can include things like physical and sexual abuse, neglect, parent separation, domestic violence and more.

Medical literature shows that ACEs affect neurological development and cause increased risk for many medical problems, including mental health and substance issues, as the child gets older.

That’s why Loma Linda University Health developed the Whole Child Assessment, which is a questionnaire given to parents or caregivers of a child during doctors’ visits.

Ariane Marie-Mitchell is a preventive medicine doctor at Loma Linda University Health.

Marie-Mitchell: “So basically over a couple of years of doing a quality improvement project where we talked to parents about their perspectives on the questions, we talked to physicians, and then we tried the instrument on a few patients and got some feedback, revised it, and tried it again. All along we were tracking rates of reporting of ACEs in children and when we first started we looked at our medical records, there wasn't any or close to zero documentation of ACEs. And by the end of the study we were getting rates of reporting of ACEs close to what you might expect from what we know about the prevalence of ACEs and the general population. So we were effective at screening for ACEs so that was the first important thing. But perhaps more importantly it was considered to be an acceptable way, by that I just mean that parents were willing to complete this questionnaire, pediatricians were willing to go over it and have the time to do it, and actually saw it as something valuable to do during their child visits.”

Marie-Mitchell says the public should know that just because a child may have been exposed to ACEs doesn’t necessarily mean they’ll develop the adverse health consequences associated with it.

Marie-Mitchell: “The very first thing that I say to parents when I'm reviewing this questionnaire with them, and if any of the risk factors come up as positive for that child, the very first thing I say is adversity is not destiny. And I've learned that that's really something important to say upfront, because if I start off with talking about ACEs are associated with all these potential health problems and school problems and social problems, you just see the blood drain from the face of the person you're talking to. And that's not really the take-home message. We want the take-home message to be, adversity is not destiny. So even though the literature is robust and tells us that ACEs are associated with risk, there's also a very strong literature on resilience and how parents and communities can support children and families so that even when there is that exposure to ACEs, there is also the potential to protect children and improve outcomes over the life-span.”

Another important thing to know, Marie-Mitchell says, is that parents should take care of their own health in order to prevent their children being exposed to ACEs.

Marie-Mitchell: “That's often the eye-opener for parents who are busy trying to do a million things for their children. And potentially neglect their own health. So when they understand that their relationship with their child is actually one of the most important things that they can do for the child and taking care of their own health supports that relationship, it helps shift that equation. Along with that is information to the parent about how do you establish a secure and nurturing relationship with the child, so information about parenting and child development that isn't widely known is really important. And last but not least, information about healthy lifestyles, it's important for the pediatrician to share with the family, if we think that ACEs increase risk of health problems by causing chronic inflammation over the lifespan, one obvious way to counter that is to promote healthy eating, exercise, regular sleep, and safety and stability in the home. So all of that is information that can be shared and it's logical in the context of the well-child visit.”

The study was published last month in the journal Global Pediatric Health.

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Most of us don't remember our first two or three years of life — but our earliest experiences may stick with us for years and continue to influence us well into adulthood.

Just how they influence us and how much is a question that researchers are still trying to answer. Two studies look at how parents' behavior in those first years affects life decades later, and how differences in children's temperament play a role.